OPTIMIZATION OF THE TREATMENT OF ENTEROATMOSPHERIC FISTULAS AS A RESULT OF ABDOMINAL EXPLOSIVE INJURIES

Abstract

Resume. About 87% of all penetrating wounds of the abdomen are accompanied by intestinal damage, which in the future can lead to the formation of enteroatmospheric fistulas. Aim. To optimize the algorithm for the treatment of enteroatmospheric fistulas, which were formed as a result of explosive wounds to the abdomen, which will contribute to the avoidance of further massive surgical intervention. Research materials and methods. The results of treatment of 17 patients with enteroatmospheric fistulas, which were formed as a result of shrapnel penetrating wounds of the abdomen, were analyzed. All patients were treated in the surgical department of the Communal non-commercial institution of the Kharkiv Regional Council “Regional Clinical Hospital” during 2022-2023. There were 9 (52.9%) female patients, 8 (47.1%) male patients. The age of the patients varied from 42 to 75 years. Research results. At the time of hospitalization, the patients were in severe and moderate condition. In 11 (64.7%) patients, in addition to enteroatmospheric fistula, phlegmon of the anterior abdominal wall occurred. In 14 (82%) patients, enteroatmospheric fistulas were formed in the areas of the jejunum and ileum, in 3 (18%) – in the colon. 9 (52.9%) patients had moderate fistula debit (from 200 to 500 ml/day), 6 (35.4%) - low (less than 200 ml/day) and only 2 (11.7%) - high (more than 500 ml/ day). A comprehensive and step-by-step approach to the treatment of patients was implemented. The first “step” was opening and draining the abscess (or fecal tract) of the anterior abdominal wall. The second “step” was to demarcate the intestinal fistula with own tissues or with the help of various “fistula adapters”. The third “step” was to install a VAC-bandage for active drainage. After 3-5 days, the VAC-bandage was replaced. On average, 2 to 4 dressing changes were required, depending on the condition of the wound. After debridement, tissue defects of the anterior abdominal wall were repaired with own tissues or ointment bandages were used. In the presented 17 cases, it was possible to avoid further massive surgical intervention (laparotomy) to eliminate the fistula. The period of inpatient treatment was (17 ± 3) bed days. Discussion of research results. In the event of an explosive injury, the prerequisites for the formation of an enteroatmospheric fistula are created. One of the complications in the healing of gunshot wounds is a fistula scar, which is a rather specific form of pathology of the wound of the anterior abdominal wall in terms of its development and course. Fistula scar is the result of phlegmon at the site of the postoperative incision, which has an indolent course. In some cases, the slow healing of the wound is accompanied by the formation of an intestinal fistula, and later - an enteroatmospheric fistula. Conclusions. The proposed algorithm makes it possible to move away from the next possible laparotomy, which makes it possible to help even very difficult patients in somatic terms. It is economically less expensive to treat enteroatmospheric fistulas according to this algorithm than to carry out a massive surgical intervention.